Health insurance for foreigners: how VšZP can participate and the state can pursue an active migration policy

The importance of access to health care probably needs no mention, as it is a fundamental human right. Unfortunately, however, we still have situations in Slovakia in which this access is limited, and not just because of a shortage of health professionals, but rather because of the set-up of health insurance and the approach of health insurance companies, especially the state-owned one. We are talking mainly about foreigners living in Slovakia, who may not only be a cost to the insurance company, but may also generate interesting income.

There are two insurance systems in the EU: the national health insurance system (the Bismarck model) and the national health system. The Bismarckian model is the one used in Slovakia and the Czech Republic, but it is typical of the Netherlands, Germany, Belgium, Austria, France and the post-communist states in Eastern and Central Europe. It is a compulsory insurance for every citizen with a contribution to a fund of health insurance companies and subsequent reimbursement to doctors and hospitals for the health care provided. The system of state insurance was applied in socialist countries (until 1990 also in Czechoslovakia) and originated in the Soviet Union before the Second World War. A slightly modified form is still applied in the UK, Italy, Portugal, Spain, Greece, Ireland, Norway, Sweden, Denmark, Australia, Canada and other countries. It represents the most widespread model of state-guaranteed health care for the entire population. It is an integrated model of state-run health care that is fully funded by the taxes of the population and the state is the guarantor of health care for all residents. In the world, we are also familiar with a third liberal healthcare system, in which there is no universal access to healthcare services for all citizens, and there are no compulsory contributions or compulsory insurance for healthcare for citizens. Of the developed countries, only the USA applies it.

Healthcare performs not only humane but also economic functions in society. The economic level is often judged from the level of health services and the health status of the population, which has an obvious impact on the economic strength of a society. The possibilities of entering the health insurance system are determined by the Health Insurance Act No. 580/2004 Coll., which distinguishes between persons with permanent residence in the Slovak Republic and persons without a permanent residence permit in the Slovak Republic, and thus a foreigner from outside the EU cannot always join the public health insurance system in the Slovak Republic, even if he or she would like to do so very much. The largest group that is thus outside the scope of the health insurance law are foreign students from third countries, who, however, from an economic point of view, could be of interest to society at a time of demographic crisis. In practice, however, it is quite different. We have about 20 000 foreign students in Slovakia, and many of them have no insurance or doctor, as they do not have an insurance card. (I described other cases back in 2020 here, and since then the number of foreigners in the categories has increased enormously.)

Historically, the Czech Republic has a very similar system to Slovakia, but they have set it up well because they simply created a supply to the existing demand and that is what the largest insurance company, Všeobecná zdravotní pojišt'ovna České republiky, did and other insurance companies in the Czech Republic have followed suit. In addition, the offer was created not only for students but also for foreigners with family reunification or for foreigners in a period of unemployment or pregnant women. A good marketing move is also the STANDART/EXCLUSIVE/PLUS choices, which adapt to the financial possibilities of foreign students. For example, STANDART costs 5680 CZK = 224 EUR/year

Všeobecná zdravotná poisťovňa in Slovakia is rather behind the times, but if it were to now set conditions for foreign students similar to those in the Czech Republic, it would be able to raise additional money and the state would be able to actively handle this insurance according to the actual need (to reduce, increase or even cancel insurance for specific categories of citizens - for example, war students from Ukraine, we have about 10 thousand of them). We have one state insurance company and it should be the one to do this, not Union or Dôvera.

This is how, for example, the Czech Republic does it

but their offer for students is the same as for all other foreigners, which is always a surprise as it doesn't show up on the page when you enter the parameters but only when you fill in the form. This offer is purely commercial and is based only on profit making and does not take into account the public interest, as a state insurance company could and should do. After all, it is not in the interest of any state that young people who choose to study in it should not be able to have normal and fair access to the health care system.